Method and apparatus for displaying medication information

ABSTRACT

A method, system, and article of manufacture for ensuring that the content and appearance of medication information is consistent, accurate, and reliable across multiple hospitals, sites, and users. Publicly available databases provide medication information. Relevant data is extracted from such databases and placed into a drug reference table. The drug reference table is combined with a hospital formulary such that the medication information in the formulary is modified, completed, reformatted, etc. Such modifications, completions, and reformatting are conducted by enforcing one or more rules that are applied to elements and attributes of a medication. The resulting medication information content is stored in a hospital formulary file that is accessed and utilized for maintaining, displaying, administering, etc. medication. To combine the drug reference table with the formulary, a hospital setup tool comprising a graphical user interface that allows a user to approve and finalize medication information may be utilized.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit under 35 U.S.C. Section 120 of thefollowing commonly-assigned U.S. utility patent application, which isincorporated by reference herein:

Utility Application Ser. No. 09/815,479, filed Mar. 23, 2001, by DonnaB. Dulong, Steven R. Wehba, Douglas W. Comer, Joanne S. Stark, MichaelA. Kurtz, and Barbara Trohimovich, entitled “METHOD AND APPARATUS FORDISPLAYING MEDICAL INFORMATION,” now U.S. Pat. No. 6,542,902, issuedApr. 6, 2003, which application claims the benefit under 35 U.S.C. §119(e) of U.S. provisional application Ser. No. 60/191,955, entitled“SYSTEM AND METHOD FOR AUTOMATING MEDICATION ERROR DETECTION ANDPREVENTION,” filed on Mar. 24, 2000, by Donna B. Dulong, et. al., whichapplication is incorporated by reference herein.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates generally to the prevention of errors inmedication administration, and in particular, to a method, apparatus,system, and article of manufacture for consistently displayingmedication information.

2. Description of the Related Art

The proliferation of new drugs and increasing complexity of drug therapyhas dramatically increased the incidence of medication errors andadverse drug events in hospitals. With the aging of the population,hospitals are treating more elderly and acutely ill patients whoseability to tolerate medication errors is compromised. At the same time,economic pressure from managed care and reduced reimbursement rates frompublic and private payors have caused hospitals to increase thepatient/nurse ratio.

The process for administering drugs to patients has changed little inthe past two decades. The process typically relies on verbal and writtencommunication and involves several different clinicians from variousareas within a hospital. Medication errors occur at every stage of themedication use process—in physician prescribing, order transcription,drug preparation, drug dispensing, and in administration to the patient.Existing information systems and automated drug distribution systemsonly incidentally address the problem of medication errors.

Several recent studies have documented the alarming rate of medicationerrors and adverse drug reactions in hospitals and their resultingdeaths and related costs. Some of the findings are as follows:

6.5% of patients will experience a potentially serious error whilehospitalized

over $4.0 billion in additional hospital costs are caused by medicationerrors and adverse drug events

Recently, the awareness of the high level of medication errors withinhospitals has increased significantly and many leading hospitals in theUnited States have experienced highly publicized cases related tocatastrophic medical errors. Lawsuits associated with medication errorshave proliferated. In addition to the legal costs, hospitals'institutional reputations may be at risk if there is a highly publicizedpatient death due to medication error.

In response to the growing risks of medication errors, leading hospitalshave developed initiatives to focus on the issue. In addition,professional associations representing nurses, hospital pharmacists, andphysicians have identified medication errors as a major issue. TheHealth Care Finance Administration (HCFA) has discussed regulations thatwould exclude hospitals with high rates of medication error fromreimbursement under the Medicare program. As a result, manyconstituencies are seeking a standard of care within hospitals toaddress the problem of medication errors and adverse drug events.

A significant cause of medication error results from the inconsistentdisplay and interpretation of medication information. Inconsistentdisplays and interpretations may arise at numerous stages in theprocessing and administration of medication including prescriptioninterpretation, prescription order transcription and entry, medicationdispensing (at a pharmacy), medication retrieval (by a nurse),medication administration, etc.

For example, a doctor may desire to write a prescription for 100 10milligram tablets of medicine XYZ to be delivered orally 2 times a day.However, when writing the prescription, the doctor may write medicineXYZ using an abbreviation (e.g., X), with a dosage of 100.0 withoutindicating the dosage unit (e.g., mg (milligram) or μg (microgram)) ordosage schedule/frequency (e.g., 2 times daily), and may fail toindicate the method of administration (e.g., oral). Such a prescriptionmay not be consistently interpreted. For example, when entering theprescription into a computer system, the pharmacist may omit some of themissing important information, wrongly interpret the abbreviation, enterthe information using abbreviations different from that used in theprescription (i.e., those used in the pharmacy's own formulary), furtherabbreviate the remaining medication information (e.g., ×2 for two timesdaily), or incorrectly indicate a dosage of 1000 micrograms to be takenthree times a day. Further errors may occur when the prescription isfilled by another pharmacist that may interpret the information in thecomputer (e.g., the abbreviations) differently, when a nursemisinterprets the computer display of the prescription and obtains thewrong medication from floorstock, or when a nurse administers themedication and misinterprets the information.

Individual hospitals and pharmacies often use differentabbreviations/formularies for medication information. Consequently, whenpersonnel move from one hospital/pharmacy to another, there is a highlikelihood that the personnel will misinterpret the medicationinformation. Additionally, the medication information (andabbreviations) used on a prescription label may differ from themedication information displayed on the computer or on a medicaladministration record (MAR) that is used to record the status andtreatment of a patient. Such differences may result in a medicationerror during the administration of the medication.

What is needed is the ability to consistently display and storemedication information such that fewer errors are made when interpretingthe information in a computer or on a MAR. Additionally, what is neededis a consistent and complete display of medication information acrossmultiple sites.

SUMMARY OF THE INVENTION

A method and apparatus for consistently and accurately displayingmedication information. Medication errors result in a significant numberof injuries and deaths each year. One cause of medication errorsincludes the lack of consistence and reliability in the content andappearance of medication information. For example, different content forthe same medication or the use of different abbreviations or terms whendisplaying the same medication may lead to the misinterpretation orimproper use of a medication.

One or more embodiments of the invention provide a method, system, andarticle of manufacture for ensuring that the content and appearance ofmedication information is consistent, accurate, and reliable acrossmultiple hospitals, sites, and users. Publicly available databasesprovide medication information. Relevant data is extracted from suchdatabases and placed into a drug reference table.

Different hospitals and pharmacies maintain internal formularies thatstore and provide access to medication information provided by thehospital/pharmacy. Such information is often incomplete, inconsistent,and varies from hospital to hospital.

The drug reference table is combined with the formulary such that themedication information in the formulary is modified, completed,reformatted, etc. Such modifications, completions, and reformatting areconducted by enforcing one or more rules that are applied to elementsand attributes of a medication. For example, rules may cause theconversion of a “T” in the formulary file to “TAB” to indicate amedication's route of administration. Similarly, leading or trailingzeroes may be removed, measurement unit abbreviations may be expanded oradjusted, capitalization may be adjusted, etc.

The resulting medication information content is stored in a hospitalformulary file that is accessed and utilized for maintaining,displaying, administering, etc. medication.

To combine the drug reference table with the formulary, a hospital setuptool may be utilized. The hospital setup tool provides a graphical userinterface with several columns. One column presents medicationinformation from the formulary. A second column presents suggestedmedication information from the drug reference table. The suggestedmedication information is obtained by attempting to match the formularyinformation with relevant fields in the drug reference table. Forexample, if the national drug code (NDC) information stored in theformulary matches a NDC number from the drug reference table, theappropriate medication information is retrieved and displayed in thesecond column.

A third column presents the final medication information to be utilizedin the hospital formulary file. Such final medication information mayinclude a medication display description that will be used when themedication is displayed. The medication display description comprisesmultiple elements of a medication and may be adjusted by the user, ifdesired. For example, the medication display description may comprise ageneric or brand display name of the medication (e.g., Morphine),followed by the strength and strength units (e.g., 200 mG).

Accordingly, a completed hospital formulary file reflects accurate andconsistent medication information that the individual pharmacy orhospital has approved. Such medication information may then be utilizedand displayed in a consistent manner to prevent medication errors. Forexample, all of the scheduled medications for a given patient mayconsistently display appropriate medication information for each patientorder. Such information may include the medication display descriptionand the dosage and route of administration information.

BRIEF DESCRIPTION OF THE DRAWINGS

Referring now to the drawings in which like reference numbers representcorresponding parts throughout:

FIG. 1 schematically illustrates a hardware and software environment inaccordance with one or more embodiments of the invention;

FIG. 2 illustrates the flow of information that enables the use anddisplay of appropriate medication descriptions in accordance with one ormore embodiments of the invention;

FIG. 3 is a flow chart illustrating the use of a hospital setup tool inaccordance with one or more embodiments of the invention;

FIG. 4 illustrates a graphical user interface utilized in mappingmedication information between a hospital/pharmacy formulary and a drugreference table in accordance with one or more embodiments of theinvention; and

FIG. 5 illustrates a graphical user interface displaying scheduledmedications in accordance with one or more embodiments of the invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

In the following description, reference is made to the accompanyingdrawings which form a part hereof, and which is shown, by way ofillustration, several embodiments of the present invention. It isunderstood that other embodiments may be utilized and structural changesmay be made without departing from the scope of the present invention.

Overview

A medication management system utilizes display rules that providemedication descriptive information that is accurate, consistent inappearance and easily recognized by system users and capable of beingsorted in a manner that ensures users have visibility to all medicationswithin either a selected generic or brand-name group. Descriptiveinformation that is controlled and managed in this manner contributes tothe overall medication management system goal of reducing, if noteliminating, potential medication errors at a patient's bedside.

Hardware Environment

FIG. 1 schematically illustrates a hardware and software environment inaccordance with one or more embodiments of the invention, and moreparticularly, illustrates a typical distributed computer system 100using a network 102 to connect client systems 104 at a client 104bedside to server computers 106. A typical combination of resources mayinclude a network 102 comprising an intranet, the Internet, LANs, WANs,SNA networks, or the like, clients 104 operating/used at a client's 104bedside that are personal computers, workstations, pen tablets, WindowsCE devices, etc., and servers 106 that are personal computers,workstations, minicomputers, mainframes, etc. Additionally, client 104and server 106 may receive input using a touch pad display 108, keyboard118, bar code scanner 120, cursor control device, or other input device.

In accordance with one or more embodiments of the invention, a network102 such as the Internet or a hospital intranet connects clients 104 toserver computers 106. Additionally, network 102 may utilize radiofrequency (RF) to connect and provide the communication between clients104 and servers 106. Clients 104 may execute a client application or Webbrowsers on display 108 and communicate with server computers 106executing Web servers 110. Such a Web browser is typically a programsuch as NETSCAPE NAVIGATOR or MICROSOFT INTERNET EXPLORER. Further, thesoftware executing on clients 104 may be downloaded from server computer106 to client computers 104 and installed as a plug in or ActiveXcontrol of a Web browser. Accordingly, clients 104 may utilize ActiveXcomponents/component object model (COM) or distributed COM (DCOM)components to provide a user interface or presentation layer on display108. The Web server 110 is typically a program such as IBM's HyperTextTransport Protocol (HTTP) Server or Microsoft's Internet InformationServer. Thus, server 106 provides business logic to control a system ofthe invention and to communicate with client 104.

In one or more embodiments of the invention, web server 110 hosts anActive Server Page (ASP) or Internet Server Application ProgrammingInterface (ISAPI) application 112, which may be executing scripts. Thescripts invoke objects that execute business logic (referred to asbusiness objects). The business objects then manipulate data in database116 through a database management system (DBMS) 114. When a developerencapsulates the business functionality into objects, the system may bereferred to as a component object model (COM) system. Accordingly, thescripts executing on web server 110 (and/or application 112) invoke COMobjects that implement the business logic. Further, server 106 mayutilize Microsoft's Transaction Server (MTS) to access required datastored in database 116 via an interface such as ADO (Active DataObjects), OLE DB (Object Linking and Embedding DataBase), or ODBC (OpenDataBase Connectivity).

Generally, these components 108-120 all comprise logic and/or data thatis embodied in or retrievable from device, medium, signal, or carrier,e.g., a data storage device, a data communications device, a remotecomputer or device coupled to the computer via a network or via anotherdata communications device, etc. Moreover, this logic and/or data, whenread, executed, and/or interpreted, results in the steps necessary toimplement and/or use the present invention being performed.

Thus, embodiments of the invention may be implemented as a method,apparatus, or article of manufacture using standard programming and/orengineering techniques to produce software, firmware, hardware, or anycombination thereof. The term “article of manufacture” (oralternatively, “computer program product”) as used herein is intended toencompass logic and/or data accessible from any computer-readabledevice, carrier, or media.

Those skilled in the art will recognize many modifications may be madeto this exemplary environment without departing from the scope of thepresent invention. For example, those skilled in the art will recognizethat any combination of the above components, or any number of differentcomponents, including different logic, data, different peripherals, anddifferent devices, may be used to implement the present invention, solong as similar functions are performed thereby.

Software Embodiments

A software product used primarily by nurses and other healthcareprofessionals in a hospital setting may be utilized in accordance withembodiments of the invention. The software product enables hospitals toreduce medication errors by electronically verifying at the patientbedside, the “five rights” (right patient, right drug, right dose, rightroute of administration, and right time) before the drug is administeredto the patient. Additionally, the software product may provide for theelectronic verification of the compliance/violation of multipleadditional compliance rules maintained by the system or entered by auser. The compliance rules provide for the verification of medicationadministration well beyond the traditional “five rights”. The systemalso provides valuable and comprehensive medication information neededto continually improve the safety and quality of the hospital'smedication management system and patient outcomes.

Multiple pharmacies and hospitals construct a formulary that is used torepresent and store medication information. Since different formulariesare constructed by multiple pharmacies over time, the medicationinformation is not represented consistently. Thus, differentpharmacies/hospitals utilize different formularies and the data andabbreviations therein to represent the same medication. Suchinconsistencies are a significant cause of medication error.

To reduce or prevent medication errors resulting from theseinconsistencies, one or more embodiments of the invention utilizevarious components that are collectively referred to as display rulesthat provide medication description information that is accurate,consistent in appearance and easily recognized by system users. Suchdisplay rules also provide the capability for the medication descriptioninformation to be sorted in a manner that ensures users have visibilityto all medications within either a selected generic or brand-name group.Descriptive information that is controlled and managed in this mannercontributes to the overall system of reducing, if not eliminating,potential medication errors at the bedside.

For example, if the dosage form in a formulary is “TAB”, one or moredisplay rule components may provide for expanding the abbreviation into“TABLET”. Similar display rule components may be utilized to convertmedication names, dosage forms, dosage route, etc. Using such displayrule components, different hospital formularies may all utilize aconsistent format for medication information. Thus, there is consistencybetween physicians, nurses, and pharmacists with respect to writing,viewing, and administering orders. Further, by mapping/converting themedication information to a consistent format, data warehousing/miningof the medication information may more easily be performed. Theusefulness of such data warehousing increases as the data is aggregatedacross multiple hospitals/pharmacies.

One or more of the following components form the basic structureutilized in accordance with one or more embodiments of the invention:

(1) Medication Description Management;

(2) Data Reconstruction;

(3) Element and Attribute Rules; and

(4) Hospital Setup Tool.

Medication Description Management

Medication descriptions must provide information that is sufficientlydetailed so that it is clearly identifiable as the “right drug”. Part ofthat need is provided for by the description's content and part by itsappearance. The medication description management component provides theoverall structure and procedure that is utilized to ensure the accuracyand consistency of a medication description's content and appearance.

FIG. 2 illustrates the flow of information as provided by the medicationdescription component in accordance with one or more embodiments of theinvention. Third party providers such as First Data Bank, Multim, orMicromedix maintain databases 202 of the medications/drugs in existence(e.g., the NDDF (National Drug Data File) from First Data Bank). Suchdatabases 202 include information such as medication names, dosageroute, allergy-drug interactions, food-drug interactions, patienteducational materials, etc. as published by the drug manufacturers andcollected by the third party providers. Relevant data 204 from database202 is extracted and input into a reference drug table 206. Accordingly,reference drug table 206 contains relevant organized medicationinformation.

The reference drug table 206 is combined with a hospital's/pharmacy'sinternal formulary 208 and assembled using a hospital setup tool 210(also referred to as the hospital formulary tool or display name managertool) into a hospital formulary file (HFF) 212. The hospital setup tool210 aids users in creating and providing consistent medicationdescription content and appearance for storage in the hospital formularyfile 212.

Accordingly, the content of a medication description and how thatcontent appears/is displayed is generated from various elements that aregathered from both the reference drug table 206 and hospital formulary208. Examples of the elements used (from both drug reference table 206and pharmacy formulary 208) to create the medication description aredisplay name, generic name, brand name, drug strength, package size, anddosage form. Various make-safe rules (see discussion below) are utilizedto calculate a set of display-related elements of the medicationdescription. The display-related elements, in turn, are used toconstruct a final displayed medication description by stringing togetherthe display-related elements in a controlled manner that determineswhich of the display-related elements are to be used, and where theelements are to be used as part of a final displayable medicationdescription.

Every medication is tested against a specified set of make-safe rules inorder to construct its final medication description. The finalmedication description is then stored in the HFF 212 as an additionalelement. Thus, the drug reference table 206, pharmacy formulary 208,make-safe rules, and hospital setup tool 210 are utilized to create thefinal medication description from various elements that are eventuallystored within the HFF 212.

Accordingly, the final medication description is provided by HFF 212,and used for display on display 108. The features that are utilized inthe creation of the medication description and final medicationdescription may be specified by the make-safe rules as described below.

Data Reconstruction

Although the database 202 or pharmacy formulary 208 may provide asignificant amount of data, the databases 202 and 208 often cannotsupply complete data that can be stored and managed in a system of theinvention. For example, medications that have a combination of drugs ofdiffering strengths do not show numerical data of the drug amounts.Further, many times, the strength units of the drugs are not provided.The system specifies how incomplete data is to be reconstructed basedupon all of the available information provided by the database 202 andpharmacy formulary 208. The numerical data can be reconstructed into thedrug reference table 206 or hospital formulary file 212 and indicate the“extrapolated units” or other missing information.

The data may be reconstructed based on the information provided.Accordingly, if the pharmacy formula 208 contains complete national drugcode (NDC) information for a listed medication, data for the medicationwith the matching NDC is retrieved from the drug reference table 206.Additionally, the system may attempt to locate a matching medication indrug reference table 206 based on one or more fields/elements frompharmacy formulary 208. For example, if pharmacy formulary 208 containsa name and administration route, the medication with a matching name(generic or brand) and administration route will be attempted. Selectedfields, from pharmacy formulary 208 may be utilized, preferred, or givenprecedence in attempting to locate a matching medication in drugreference table 206. Such precedence resolves inconsistencies with thedata in pharmacy formulary 208.

Element and Attribute Rules

Element and attribute rules are applied to elements and attributes of amedication to ensure the medication maintains consistent and accuratecontent and appearance. The rules may be used to create new attributesand elements or to ensure the accuracy of information in existingattributes and elements.

A final medication description's content and appearance may be basedupon various elements. One such element is a “display name” element. The“display name” element may have two forms: one display name based uponthe medication's generic name, the other based upon its brand name (bothof which are maintained in drug reference table 206). The purpose ofhaving the two forms allows the medications to be sorted by eithergeneric or brand name, thereby providing the user with an option if oneof the names is known and not the other.

Element and attribute rules may be grouped into various categoriesfocusing on specific aspects of the elements of a medication descriptionas follows:

Make Safe Rules

As described above, the medication descriptions are based upon thegeneric and brand names extracted from database 202. After obtaining adisplay name for a medication, the name must be formatted forappropriate use and display. Make safe rules are utilized to format andadjust the medication descriptions for this purpose. Make safe rulesprovide for formatting the display names for easier reading andmodifying the display names so that the reference drug table 206acronyms, abbreviations, and typographical errors are transformed intofull and complete terminologies that are consistent across the entirespectrum of all medications placed into HFF 212.

The make safe rules gather the data from various elements to ensure thatdetailed medication information is accurate and consistent. Make saferules provide the ability for server 106 to create “safe” values forvarious drug attributes/elements, including proper spacing and specialformatting. Accordingly, some “make safe” rules ensure that certainfields are in the proper format and contain the appropriate information.For example, when a “make safe” procedure is called, the procedure mayensure the proper format and information is maintained for drug strengthunits, drug strength volume units, max daily dose units, etc.

A single “make safe” procedure may be utilized in accordance with one ormore embodiments of the invention. When the single “make safe” procedureis called, the caller includes the attributes/elements to make safe asparameters of the function call. The “make safe” procedure returns avalue that has been made “safe”.

Units of Measurement Rules

One or more make safe rules may be applied to elements related to theunits of measurement (UOM) for the medications. A UOM specifies the unitutilized to quantify and measure the medication. For example, a UOM maybe Billion Units, mL, mm, 1000, etc. A UOM may comprise a stringcomponent and a numerical value component. For example, the UOM stringcomponent may be gram or G, and the UOM numerical value component may be1,000,000, 1,000, etc.

Make safe rules that are UOM (referred to as UOM rules) related ensurethat both the string and numerical value are consistent units ofmeasurement across all medications. For example, one UOM rule removestrailing zeroes from the numerical value (e.g., 1 and not 1.0). AnotherUOM rule stores leading zeroes in the numerical value (e.g., 0.1 and not0.1) and add commas for numbers greater than or equal to 1000 (e.g.,1,000). An additional UOM rule modifies the UOM string to ensureconsistent capitalization and abbreviation. For example, CM is changedto cm, ML is changed to mL, centimeters is changed to cm, and “″” ischanged to inches.

UOM rules may also modify the string or numerical value depending oneach element's value. For example, if the string is “G” and thenumerical value is less than 1, the string may be converted to mg andthe numerical value may be multiplied by 1000. In another example, ifthe numerical value is 1,000,000,000, the string may be modified to“Billion Units”. In another example, if the string is “MU,” and thenumerical value is greater than or equal to 1,000,000, then the stringmay be changed to “Billion Units” and the numerical value may be dividedby 1,000,000. Inconsistencies between the numerical value and string mayalso be located and adjusted. For example, if the numerical value is1,500,000 and the string is BU or Billion units, the numerical value maybe given precedence such that the string is changed to Million Units.

UOM rules may also ensure proper spacing between strength numbers, unitvolume, weight, and rates. For example, a UOM rule may ensure that thereis a space between a strength number and units (e.g., 5 mL and not 5mL). In another example, a make safe rule may ensure that numericalvalues are used in weights and rates (e.g., 50 mL/1 hr and not 50mL/hr).

Accordingly, the UOM rules ensure that both the string and numericalvalue are consistent units of measurement across all medications.

Compression Rules

Compression rules provide for creating “compressed” values of drugattributes/elements and ensuring that drug strength values are createdand stored within a 10-character limit. Compression rules include theremoval of trailing and leading zeroes and spaces, the removal of spacesand dashes in fractions (e.g., 1-½ becomes 1½), and the abbreviation ofcommon terms (e.g., in becomes″, feet becomes ft, etc.).

Display Name Creation and Storage Rules

For each medication item, display name creation and storage rulesprovide for the creation and storage of generic and brand names for themedications that are displayed on display device 108. Such rules mayutilize and refer to a spreadsheet file containing the relevantdescription/elements.

To provide an initial medication description that is used internally forapplying and modifying rules and to obtain desired ordered medicationdescriptions, the following attributes may be concatenated with singlespace separators between each attribute:

(1) display name (generic or brand);

(2) display strength;

(3) display package strength;

(4) display package amount;

(5) display package size;

(6) display package description; and

(7) display dosage form.

Each of the above attributes is based on additional attributes. Forexample, the display package size attribute may be a combination of thepackage size and the package size units from drug reference table 206.Further, a make safe procedure that ensures proper formatting,capitalization, spacing, etc. may be executed to create/determine eachof the above attributes. For example, the following code may be utilizedto create the display package size attribute:

DisplayPackageSize=MakeSafe(Str(PackageSize)+(PackageSizeUnits)

In addition to the medication description that utilizes the aboveelements, the system may generate a different final medicationdescription that is utilized to present the medication description on adisplay 108 to users. The final medication description may utilize thefollowing elements, if available:

(1) the generic or brand display name;

(2) the display strength; and

(3) the display dosage form.

Subsequent to the above three elements, the route information isinserted (if not already present). For example, if the medication is anose/nasal spray, the delivery route “nasal” may be inserted into thefinal medication description. Similarly, the medication delivery routeterms ophthalmic, otic, etc. may be inserted into the final medicationdescription.

The final medication description may also be modified based on asequence number for specific medications. For example, if a medication'ssequence number matches a sequence number in a predefined table, thefinal description may be modified such that the medication name isfollowed by the display package amount and the display package size. Forexample, the final medication description from a predefined table may be“Lidocaine+DisplayPackageAmount+“in”+DisplayPackageSize+“_D5W”s.

The final medication description also includes a default strength andstrength units that may be retrieved from a predefined table or based onadditional attributes/elements.

Package Size Units Rules

For each medication item, the package size units is obtained and stored.During the obtaining process, formatting issues such as capitalizationand abbreviations are corrected. For example, “TAB” may be changed to“Tab”, “CAP” may be changed to “Cap”, and “BAG” may be changed to “Bag”.Additionally, predefined reference numbers may be converted to thecorresponding package size units. For example, if a dosage form is “2”,the package size may be converted to “mL”.

If medication strength values are not provided or available in the drugreference table 206, package size rules add appropriate values. Forexample, if the generic or brand name of the medication contains theword “child”, the medication strength may be specified as “PEDIATRIC”.

Medication strength related elements may be adjusted based onindependent information available to the system. Accordingly, generalindependent strength related information is obtained and detailedinformation that is consistent therewith is determined. Relevantelements and fields may be compared to tables containing data and emptyfields may be instantiated when a match is found. For example, a “makesafe” procedure may be called that utilizes, compares, and confirms thatthe independent information is not inconsistent and may suggest or adoptadditional strength related information based on the independentinformation. In a specific example, a make safe procedure may retrieveindependent information that provides for a single component and timerate strength. The component and time rate strength information isconverted into specific information for UOM strings. Thus, if the drugstrength is *MM/*ML, then the unit is milliMoles per volume, and theappropriate strength related information such as strength units, volumeunits, display strength, etc. are instantiated with the appropriateinformation. In another example, a search for a sequence number in atable may be conducted and strength related values from the table into adrug object item may be instantiated if the sequence number is found.

Hospital Setup Tool

Substitutions and modifications of the medication description to ensurethat the data is reconstructed accurately may be performed by clinicalpersonnel using the hospital setup tool (HST)/display name manager tool210 to create a set of accurate and consistent display names in thehospital formulary file 212.

Using the HST 210 and the data from drug reference table 206, pharmacyformulary 208, and the make safe rules, detailed medication informationmay be adjusted and modified. Thereafter, a final medication descriptionis created for each medication to be stored in the formulary file 212 byappending various display-related elements to the display name in asoftware-controlled process based upon certain medication parameters.

The hospital setup tool 210 provides for the verification of medicationinformation utilized in a hospital formulary file 212. FIG. 3 is a flowchart illustrating the use of the hospital setup tool 210 in accordancewith one or more embodiments of the invention. Three primary steps areinvolved in properly configuring and setting up the hospital formularyfile 212 using the hospital setup tool 210: (1) importing formulary data302; (2) mapping the formulary data; and (3) outputting the appropriatedata into the hospital formulary file 212.

Importing pharmacy formulary data 208 is the first step 302 in settingup the hospital formulary file 212. The pharmacy formulary data 208 isusually comma separated data regarding medications offered by apharmacy. The formulary data 208 is parsed at step 308 to find andcorrect any formatting errors. For example, the lengths of fields may becompared to maximum field lengths, dashes in NDC numbers may be removed,primary keys (e.g., row IDs) may be checked for uniqueness, and fieldsthat should only contain numerals or letters are checked to ensure thatonly numerals or letters ate contained within them. A summary of theformatting errors that could not be automatically corrected may bepresented to the user. The user may then have the option to manuallycorrect the appropriate entries at step 310.

Once the formatting of the formulary data 208 has been modified (ifnecessary) and accepted by the user, the formulary data 208 is inputinto an internal database/table of the data referred to as the HST(hospital site table) site formulary. Once the data is input into theHST site formulary, the importing process 302 is complete.

Step 304 (mapping the data) provides the user with the option to map thepharmacy formulary data 208 to drug reference table data 206 and toview, modify, and accept the medication description. FIG. 4 illustratesthe graphical user interface utilized in mapping step 304. At step 314,the formulary data from the pharmacy formulary 208 is listed (e.g., incolumn 402).

At step 316, the system attempts to match the pharmacy formulary data208 with data from the drug reference table 206. If a match or potentialmatch are found, the suggested drug reference table data 206 may belisted (e.g., in column 406) at step 318. Additionally, the informationthat the user elects to use to represent each element in the hospitalformulary file 212 may be listed (i.e., in column 404). For ease of use,the individual elements of a medication description may be displayed inindividual fields with each field of the pharmacy formulary data 208adjacent to or in the same row of a corresponding element that issuggested. For example, the row indicating the dosage form 408 of amedication may indicate the type of field (i.e., “Dosage Form:”) in onecolumn, the pharmacy/site formulary dosage form in a second column 402(i.e., “CAPSULE”), the item to be created in a third column (i.e.,“Capsule, Hard, Soft, etc. (Cap . . . ”) 404, and the suggestion/matchin a fourth column 406 (i.e., “Capsule, Hard, Soft, etc. (Cap . . . ”).

Once both the formulary data 208 and the suggestion from drug referencetable 206 are displayed, modifications to the medication information maybe obtained from the user at step 320. The user examines each medicationusing the graphical user interface (GUI) of FIG. 4. As described above,each column in the GUI comprises information relating to the medication.One column (e.g., column 404) is utilized to display the user'sselection of the final representation and form of the data. The defaultinformation contained within the column 404 may be the suggestion/matchfrom column 406. Further, certain elements may not be modifiable by theuser (e.g., the generic or brand name). A user can elect toautomatically transfer the text from column 402 (i.e., the pharmacyformulary data 208) or from column 406 (i.e., the suggested/matched data206) into column 404.

The user can manually modify the data in column 404 by deleting,copying, typing, etc. directly into the fields in column 404. If data incolumn 404 is changed by the user, upon the user electing to save thedata, the medication description data 410 may be modified to reflect thechanges. Accordingly, the medication description 410 is based on theelements (from column 404) used to represent the medication. Further,the medication description 410 can be modified directly to add desiredinformation or notes to be displayed (e.g., “MUST BE ORAL”). Themedication description 410 of column 404 is the description that will bedisplayed and utilized by users of the system. Accordingly, thedescription should be consistent across multiple sites. By providing thesuggestion from column 406 and the ability for a user to modifymedication information, the appropriate medication and a consistentdisplay/reference to the medication is utilized.

The GUI of FIG. 4 may also provide flags or color coding to indicatewhen changes have been made or when particular fields need to beconfirmed/checked. For example, if the user modifies a field in column404 that differs from the suggestion in column 406, a flag may bedisplayed adjacent to the row containing the modified entry.Alternatively, the changed field may be highlighted or displayed in adifferent color.

If important information is changed by the user at step 320, the usermay be prompted to confirm the change and/or to confirm whether theupdated or original information should be utilized when clinical checksare conducted. In other words, the user is given the option of whetheror not to link to the remaining data (that is not hidden from the user)for the medication as suggested in column 406.

Once linked, the data for the medication indicated in column 406 isutilized in clinical checks. As described above, clinical checks confirmthat the administration of medication does not violate a series of rulesand provide warnings to users when a rule violation occurs. For example,if a nurse attempts to administer secobarbital by injection, a link tothe route information in column 406 may enable the display of a warningto the nurse to administer the prescription orally. Further, informationrelated to secobarbital but not displayed in the GUI may also beutilized.

Linking may be desirable because some clinical rules may need clinicalinformation for the linked drug even if a field has been changed. Forexample, if the package size is changed or a percentage value ischanged, the information for the medication may still be utilized inclinical checks. Alternatively, linking may not be desirable if themedication has been significantly changed in column 404 from that listedin column 406. For example, if the user is listing a banana as amedication in column 404 and the only suggestion that is found is foropium, the user would likely not want to link the banana to opium suchthat clinical checks will use the attributes for opium when a banana isprescribed. In another example, suppose secobarbital is traditionallyadministered orally but the hospital is utilizing a new method ofcrushing the pill, mixing the pill with intravenous fluid (IV) andadministering the mixture through intravenously. In such a situation,the pharmacist still needs to modify the information in column 404.However, the pharmacist may still desire to link the new mixture to theoriginal secobarbital record in column 406 for use in clinical checks.Accordingly, the pharmacist is provided the option of linking themedication to the original medication or match listed in column 406.

Step 316 attempts to match the site formulary data 208 with drugreference table data 206. Once a match is found, column 406 displays theresulting match. If the displayed information in column 406 is not theappropriate medication/information, a user may directly enter theinformation and/or search for the appropriate medication/information byselecting the find button 412. In response, a GUI for conducting a queryof the drug reference table 206 information may be utilized to searchand retrieve medication information. Additionally, a “smart” search maybe conducted that provides the ability to locate the “best” match basedon the dosage form, brand name, dosage strength, and/or generic name.Using a smart search, if an exact match cannot be found, the GUIdisplays a list of those medications that contain the most matches. Theuser may select one of the listed medications to retrieve the relatedmedication information. Once selected, the retrieved information isdisplayed in column 406 for the user to work with and modify if desired.

If the desired medication is not suggested (or cannot be found by theuser), the approval of the formulary information in column 402 may bepostponed until a later time by selecting the postpone button 414.

The system may also maintain a full audit trail that tracks any changesmade in column 404, who made the changes, what the user was viewing whenthe change was made, when the changes were made, what questions wereanswered (and the responses to the questions), and other relevantauditing information. Accordingly, when mistakes are encountered, theaudit trail may be viewed to determine the relevant information aboutthe user and the actions taken when the mistake was entered into thesystem.

Once the user using the GUI of FIG. 4 has verified all of themedications, a final verification screen provides the user with theoption to save and/or export the validated medication data. Accordingly,once the medications have all been verified, mapping step 304 iscomplete and the data may be output to the hospital formulary file 212at step 320. Further, once the user has selected to save/output thedata, various formatting checks may be performed once again. Forexample, the system may ensure that primary keys are unique, fieldlengths are appropriate, and characters and numerals are utilizedappropriately. Once saved/output to the HFF 212, the HFF 212 may beutilized and accessed to retrieve medication information and to obtainthe medication description to be displayed/utilized throughout thesite/hospital.

Accordingly, the medication description management, make safe rules,data reconstruction, and hospital setup tool components are utilized toprovide accurate medication description content and appearance.

Graphical User Interface

Once the medication elements, attributes, and descriptions have beenmade “safe”, and transferred into HFF 212, a graphical user interface(GUI) provides for the display of the relevant information in variousformats and screens/areas.

GUI display areas may include a components display and a medicationsdisplay. The components display may include various tabs for listing thecomponents, entering observations, and entering the administration ofthe component. The medications display may include a scheduledmedications screen, a PRN screen, an IV screen, an all screen, afloorstock screen, and a formulary screen.

To ensure that the medication orders properly and consistently identifythe medication and comply with the five patient rights (i.e., rightpatient, right drug, right dose, right route of administration, andright time), the elements and attributes from HFF 212 are utilized andthe medication description utilized remains consistent throughout all ofthe display screens. Further additional compliance checks may beperformed using the elements and attributes from HFF 212 to protectagainst medication errors.

Accordingly, medications on each screen are displayed using threecolumns. The first column contains either the generic or brand finaldisplay medication description depending on the user's selection. Column2 comprises either the display package size, display package strength,or display strength. Column 3 comprises either the display packagedescription, display dosage form, or an empty field. Using thisthree-columnar format, relevant consistent medication information thatprovides the ability to properly and completely identify the medicationis displayed and utilized by the user. For any patient order, themedication displayed always provides the order give amount, the ordergive units, and the order display name (created using the final displaymedication description). Additionally, a pop-up window containing theentire medication description may be displayed when the display cursoris placed over any listed medication/order.

For component orders, a components tab/screen with each component andthe amount of the component is provided. Component orders are orderswherein various components are added together to create a completeproduct. For example, a component order may call for the use of eight(8) different components to utilize in an intravenous solution (e.g.,600 mL Dextrose in Water, 400 mL Sterile Water, 250 mL Fat Emulsions10%, 40 mEq KCI, 4.65 mEq CaGlucon, 8 mEq MagSulf, 10 mM Kphos, andNaPH).

FIG. 5 illustrates a scheduled medication GUI screen in accordance withone or more embodiments of the invention. A scheduled medicationlist/screen identifies dose times/time due of the medication (usingmilitary time) 502, the name of the medication (using the consistentmedication description) 504, and the last time the medication wasadministered (if any) 506. Additionally, the screen may indicate whetherthe scheduled medication is for a confirmed and active order and mayprovide a list of previously administered medications. When a nurseelects to administer a particular listed/scheduled medication, detailsof the medication are displayed. For example, when a nurse selects aparticular prescription for administration, the route of theadministration (e.g., IV) is displayed to the nurse.

The PRN screen provides for medications that are pro re nata (given ondemand). The PRN medication is listed with the consistent medicationdescription followed by the last time the PRN medication wasadministered in a separate column. The PRN screen follows the sameguidelines utilized for the scheduled medications screen.

The IV screen displays all of the IV medication orders for a givenpatient. Each medication listed in the IV screen is also accompanied bythe strength and rate for administering the medication intravenously.

The all medications screen/list provides details on all patient ordersand medications (IV, PRN, or otherwise) for a given patient. Eachmedication/patient order is listed with the appropriate strength,dosage, rate, etc. related information as provided on the other screensof the GUI. For example, the time the medication was last administeredand the order state (e.g., active, on hold, future, expired, etc.) maybe displayed adjacent to PRN and scheduled medications.

The floorstock screen provides a listing of the patient orders/scheduledmedications that are retrieved from the floorstock where the patient islocated. For example, Tylenol may be retrieved from the floorstock andadministered to the patient.

The formulary screen provides a listing of the patient orders/scheduledmedications that are obtained/retrieved from the hospital's pharmacy.Such medications can include pain medications such as Morphine ortablets of antibiotics such as Keflex.

Once the nurse or person administering the medication selects amedication from one of the above screens, detailed information regardingthe medication is displayed to the user. The detailed information allowsthe administer of the medication to confirm or delete one, some, or allof the medications as they are administered to the patient. Aconfirmation screen may present additional information such as the timethe medication was administered, the name of the administer of themedication, and a co-signature (if required for the medication).Additionally, the confirmation or detailed medication screen mayindicate the dose amount, dose unit, rate, route units, and route.

Conclusion

This concludes the description of one or more embodiments of theinvention. The following describes some alternative embodiments foraccomplishing the present invention. For example, any type of computer,such as a mainframe, minicomputer, pen tablet, CE device, or personalcomputer, or computer configuration, such as a timesharing mainframe,local area network, or standalone personal computer, could be used withthe present invention. In summary, embodiments of the invention providethe ability to consistently display access, and utilize medicationinformation including medication descriptions.

The foregoing description of the preferred embodiment of the inventionhas been presented for the purposes of illustration and description. Itis not intended to be exhaustive or to limit the invention to theprecise form disclosed. Many modifications and variations are possiblein light of the above teaching. It is intended that the scope of theinvention be limited not by this detailed description, but rather by theclaims appended hereto.

We claim:
 1. A computer-implemented method for displaying consistentmedication information comprising: creating an electronic drug referencetable comprised of medication information; receiving an electronicformulary comprising formulary medication information; creating anelectronic formulary file comprising medication information content,wherein the medication information content comprises a combination ofthe electronic drug reference table and the electronic formulary; anddisplaying the medication information content.
 2. The method of claim 1,wherein the medication information is obtained from one or more drugmanufacturers.
 3. The method of claim 1 wherein the medicationinformation content is displayed at a time of administration ofmedication.
 4. The method of claim 1 wherein the medication informationcontent is displayed at a time of prescribing medication.
 5. The methodof claim 1 wherein the medication information content is displayed at atime of computerized prescription order entry.
 6. The method of claim 1wherein the electronic formulary is received from a hospital.
 7. Themethod of claim 1 wherein the electronic formulary is received from apharmacy.
 8. The method of claim 1 wherein the creating of theelectronic formulary file further comprises applying one or more rulesthat ensure the medication information content and appearance isconsistent and accurate.
 9. The method of claim 1 wherein the creatingcomprises providing a hospital setup tool that enables a user to modifyand approve medication information content to be placed into theelectronic formulary file.
 10. The method of claim 1 wherein themedication information content displayed is based on patient orders fora specified patient.
 11. An apparatus for displaying consistentmedication information in a computer system comprising: means forcreating an electronic drug reference table comprised of medicationinformation; means for receiving an electronic formulary comprisingformulary medication information; means for creating an electronicformulary file comprising medication information content, wherein themedication information content comprises a combination of the electronicdrug reference table and the electronic formulary; and means fordisplaying the medication information content.
 12. The apparatus ofclaim 11, wherein the medication information is obtained from one ormore drug manufacturers.
 13. The apparatus of claim 11 wherein themedication information content is displayed at a time of administrationof medication.
 14. The apparatus of claim 11 wherein the medicationinformation content is displayed at a time of prescribing medication.15. The apparatus of claim 11 wherein the medication information contentis displayed at a time of computerized prescription order entry.
 16. Theapparatus of claim 11 wherein the electronic formulary is received froma hospital.
 17. The apparatus of claim 11 wherein the electronicformulary is received from a pharmacy.
 18. The apparatus of claim 11wherein the means for creating the electronic formulary file comprisesmeans for applying one or more rules that ensure the medicationinformation content and appearance is consistent and accurate.
 19. Theapparatus of claim 11 wherein the means for creating comprise means forproviding a hospital setup tool that enables a user to modify andapprove medication information content to be placed into the electronicformulary file.
 20. The apparatus of claim 11 wherein the medicationinformation content displayed is based on patient orders for a specifiedpatient.
 21. An article of manufacture comprising a program storagemedium readable by a computer and embodying one or more instructionsexecutable by the computer to perform a method for displaying consistentmedication information, the method comprising: creating an electronicdrug reference table comprised of medication information; receiving anelectronic formulary comprising formulary medication information;creating an electronic formulary file comprising medication informationcontent, wherein the medication information content comprises acombination of the electronic drug reference table and the electronicformulary; and displaying the medication information content.
 22. Thearticle of manufacture of claim 21, wherein the medication informationis obtained from one or more drug manufacturers.
 23. The article ofmanufacture of claim 21 wherein the medication information content isdisplayed at a time of administration of medication.
 24. The article ofmanufacture of claim 21 wherein the medication information content isdisplayed at a time of prescribing medication.
 25. The article ofmanufacture of claim 21 wherein the medication information content isdisplayed at a time of computerized prescription order entry.
 26. Thearticle of manufacture of claim 21 wherein the electronic formulary isreceived from a hospital.
 27. The article of manufacture of claim 21wherein the electronic formulary is received from a pharmacy.
 28. Thearticle of manufacture of claim 21 wherein the creating of theelectronic formulary file further comprises applying one or more rulesthat ensure the medication information content and appearance isconsistent and accurate.
 29. The article of manufacture of claim 21wherein the creating comprises providing a hospital setup tool thatenables a user to modify and approve medication information content tobe placed into the electronic formulary file.
 30. The article ofmanufacture of claim 21 wherein the medication information contentdisplayed is based on patient orders for a specified patient.